Covered? You’ll find out when you claim
Health insurance policyholders in India are facing long legal battles over rejected claims due to undisclosed pre-existing conditions or disputed hospitalizations. Consumer forums are increasingly ruling in favor of patients against insurers who use technicalities to deny coverage.
Why it matters
This reflects a systemic issue in the Indian insurance sector where policyholders struggle to access promised benefits during medical emergencies.
Buying a health insurance policy can take half an hour. Fighting a rejected claim can become a long ordeal. For a 69-year-old Surat man, it took 12 years. His battle began after he suffered an acute stroke in Manchester, UK, in 2009. His insurer initially approved cashless treatment there but later refused to pay, citing 15 years of undisclosed diabetes. He paid the 4,283-pound bill (about Rs 3.5 lakh) himself, and went to the Surat district consumer court and won. The insurer appealed before the state consumer commission and lost, then took the case to the national consumer commission. In 2021, the commission dismissed the insurer’s appeal as lacking merit, calling diabetes and hypertension lifestyle diseases.Across Gujarat, claims have been contested over undisclosed illnesses, hospitalisation, paperwork discrepancies, blacklisted hospitals and whether procedures were medical or cosmetic.
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